Provider Demographics
NPI:1922007905
Name:BUFFINGTON, MICHAEL L (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:BUFFINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1266
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-1266
Mailing Address - Country:US
Mailing Address - Phone:479-521-1420
Mailing Address - Fax:
Practice Address - Street 1:34 W COLT SQUARE DR STE 3
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2888
Practice Address - Country:US
Practice Address - Phone:479-521-1420
Practice Address - Fax:866-286-2967
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4241207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR12471000000OtherQUALCHOICE
AR137676001Medicaid
AR50748OtherBLUE CROSS BLUE SHIELD
AR50748Medicare PIN
AR50748OtherBLUE CROSS BLUE SHIELD
AR137676001Medicaid